NEHTA takes over consumer PCEHR registration contract

The National E-Health Transition Authority (NEHTA) has taken over responsibility for a contract with McKinsey to boost consumer registrations for the PCEHR from the Department of Health (DoH), according to statements at last week's Senate Estimates hearing.

Linda Powell, first assistant secretary for eHealth policy, change and adoption in the department's eHealth division, said DoH was no longer handling a contract with McKinsey, which had sub-contracted Aspen Medical to register consumers in hospitals and some aged care facilities and general practices.

Ms Powell said Aspen had delivered 580,000 registrations during the contract, which began in March/April and which upset some Medicare Locals, who were doing similar work.

Ms Powell told the Senate hearing that NEHTA now had a similar contract with McKinsey and the health department was no longer involved. A NEHTA spokesperson has subsequently confirmed this.

“They are under contract to deliver a further 150,000 by the end of December,” Ms Powell said.

She said that as the contract with McKinsey was a commercial arrangement, she could not reveal the cost of the contract.

DoH CIO Paul Madden said assisted registration using Medicare Locals and contractors like Aspen had given better results than advertising in GP clinics or hospitals, or through some Medicare Local activities.

He said direct assisted registration through hospital information systems and GP practice management software would make the consumer sign-up process easier.

Several medical practice software packages, including Communicare and Genie, already have an in-built assisted registration function, while others such as Best Practice plan to include it in their next releases.

Aged care software vendors such as iCareHealth and TCM are also working on an assisted registration function, but are also using the department's assisted registration tool (ART).

Asked by committee chair Sue Boyce whether he agreed that the difficult sign-up process for the PCEHR was a barrier to entry for consumers, Mr Madden said the department had learned quite early that the online registration process was cumbersome.

“We went through a usability testing process with real consumers and we came back with some significant changes to simplify it,” he said. “We have made releases to the system probably on three other occasions since the system's inception to make the process easier.”

Ms Powell told the hearing that as of last Tuesday, 1,129,153 consumers were registered in the system.

There were 6040 healthcare provider organisations registered including 4714 general practices, but the department does not have figures on the number of clinicians that are using the system, she said.

“An 'organisation' is quite variable in terms of what it might be: it might be a small general practice with one or probably more GPs but it could also be the entire state health system, as it is in Queensland, in which case it would provide coverage for all of the doctors that work in Queensland hospitals,” Ms Powell said.

She said 11,136 shared health summaries had been uploaded.

Since the hearing, the Department of Health has provided updated figures. DoH says over 1.4 million people have now registered. There are 6000 healthcare provider organisations and more than 8200 individual healthcare providers who are registered to use the system

There are over 11,200 shared health summaries entered by healthcare providers and over 3700 hospital discharge summaries recorded. The number of prescription and dispense records is over 43,800, a DoH spokesperson said.

Asked if the roughly one per cent of people with a PCEHR who have had a shared health summary uploaded was a good number, Mr Madden said the number of shared health records as a percentage of the population was “running at a sharper take-up than what we had in the Northern Territory”, referring to the introduction of the NT's My eHealth Record (MeHR) over a number of years.

“The Northern Territory, across a period of five years, reached a point of 90 per cent saturation of their consumers, and they now have about 40,000 clinical documents added to the system each week,” he said. “It takes some time for the whole community to embrace and push these things through.”

DoH secretary Jane Halton said that in terms of the department's expectations about what is a reasonable take-up rate, “I think the answer is: compared to our domestic experience, yes, it is reasonable; and compared to what I know about international experience, yes, it is reasonable”.

Senator Boyce pressed Ms Halton on whether the department had a target for the shared health summaries per registered consumer.

“What becomes a realistic and sensible target whereby it actually becomes something that is useful to us?” Senator Boyce said. “There must be a threshold of people who are engaged and using it before it becomes a cost saving to the system.”

Ms Halton said the department did not have a numerical target. “This is something, obviously, that we would imagine that the [PCEHR review panel] will think about in terms of usability et cetera. At the moment there is no promulgated target in this area.”

Senator Boyce said it seemed to her that DoH was not getting “any bang for your buck” with $1 billion spent and only one per cent of PCEHR registrations with a shared health summary.

Ms Halton said the billion dollars was comprised of a number of elements. “The large majority of the billion dollars is actually things like the standards that underpinned the use of all IT systems in the health space,” she said.

“[T]hose things are already fundamental to the operation of electronic systems in states and territories … The PCEHR is actually the smaller proportion of that amount. The majority of it is actually creating the things that prevent a 'rail gauge' problem in terms of electronic commerce, communication and clinical information.”

Posted in Australian eHealth

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